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UWorld Questions I Missed > April 30-May 31 > Flashcards

April 30-May 31 Flashcards

1
Q

sporotrichosis

A

a subcutaneous fungal infection caused by sporothrix schenckii

dimorphic fungus found in the natural environment in the form of mold (hyphae)

resides on the bark of tress, shrubs, and garden plants and on plant debris in soil

enters thru breaks in the skin and spreads along lymphatics

histo: granuloma with histiocytes, multinucleated giant cells, and neurophils surrounded by plasma cells

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2
Q

midgut volvulus

A

at 6 weeks gestation, midgut (SMA) herniates through the umbilical ring

incomplete counter clockwise rotation results in midgut malrotation

cecum rests in RUQ and Ladd’s fibrous bands connect the retroperitoneum in the RLQ to the right colon/cecum by passing over the 2nd part of duodenum

billious emesis during the first days of life

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3
Q

apoliporpotein E-4 allele

A

homozygotes: late onset familial Alzheimer disease

ApoE4 protein might be involved in the formation of senile plaques

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4
Q

avascular necrosis

A

caused by sickle cell disease, vasculitis, high dose corticosteroid treatment, alcoholism

presents with chronic, progressive groin and hip pain that is exacerbated by weight bearing

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5
Q

carcinoid heart disease

A

excessive secretion of serotonin stimulates fibroblast growth and fibrogenesis

cardinoids are well differentiated neuroendocrine tumors that are found most commonly in the distal small intestine and proximal colon, with a strong propensity for metastasis to the liver

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6
Q

triglyceride metabolism

A

triglyceride–>glycerol+FFA–>glycerol3P–>DHAP–>energy and glucose

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7
Q

cardiac tamponade

A

hypotension, tachycardia, jugular venous distension with clear lungs, pulsus paradoxus (palpable pulse during inspirationand >10 mmHg decrease in SBP on inspiration)

viral pericarditis can be a precipitating cause

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8
Q

narcolepsy

A

chronic sleep disorder characterized by frequent overwhelming urges to sleep

cataplexy: sudden loss of muscle tone that occurs in respone to intense emotions

caused by depletion of hypocretin-secreting neurons in lateral hypothalamus

shortened sleep latency and enter REM sleep almost immediately

experience intrusions of REM sleep

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9
Q

hypersomnolence

A

excessive and impairing daytime sleepiness that can’t be explained by another sleep disorder

persistent daytime sleepiness rather than sleep attacks

typically do not feel refreshed after naps (like narcolepsy)

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10
Q

orbital floor

A

comprised of zygomatic bone and maxilla

infraorbital nerve (from maxillary) runs along the orbital surface of the maxilla in the infraorbital groove before transversing the infraorbital canal and exiting the skull via the infraorbital foramen

damage results in: numbness and paresthesia of the upper cheek, upper lip, and upper gingiva

can also cause enophthalmos and entrapment of the inferior rectus muscle

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11
Q

internal hemorrhoids

A

originate above the dentate line

abnormal distension of the anal arteriovenous plexus which normally forms the anal cusions

chronically increased venous pressure due to prolonged straining or breakdown of supporting tissue due to advancing age

rubber band ligation include superior rectal vein and inferior mesenteric vein

no somatic sensory nerves so can’t be painful

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12
Q

external hemorrhoids

A

originate below the dentate line

drain via the inferior rectal vein into the internal pudendal vein which communicates with the internal iliac veins

innervated by sensory nerves that cover the perianal area and are very sensitive

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13
Q

hydrocele of the testicle

A

collection of peritoneal fluid within the tunica vaginalis that occurs when it remains patent and allows peritoneal fluid to accumulate in the tunica vaginalis

presents in newborns as a painless scrotal swelling that transilluminates

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14
Q

high altitudes

A

PiO2 falls which leads to low PaO2

hyperventilation leads to decreased paCO2–>respiratory alkalosis, increased pH

loss of HCO3 occurs 1-2 days later

compensatory to long term: increased 2,3-DPG, increased hemoglobin, increased pulmonary diffusing capacity, VEGF increase, increased mitochondria, hemoconcentration

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15
Q

genetic reassortment

A

influenza viruses have surface proteins of HA and NA which are under constant selective pressure both to maintain species specific virulence and evade immune recognition

segmented genome coded by separate RNA segments allows for genetic reassortment

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16
Q

streptococcus pyogenes

A

major virulence factor: Protein M–> inhibits phagocytosis and complement activation

Streptolysin O and DNAse both are specific for s. pyogenes but don’t convey resistance to phagocytosis

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17
Q

pyridoxine

A

vitamin B6

used for the transamination and decarboxylation of amino acids, gluconeogensis, and other biochem properties

typically occur between an amino acid and a-keto acid

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18
Q

cholesterol gallstones

A

increased cholesterol, decreased bile salts, decreased phosphatyidylcholine

presents as 1 month history of dull abdominal pain that occurs after eating

localized to the RUQ and especially severe after fatty meals

uS reveals several mobile, echogenic foci within the gallbladder lumen

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19
Q

doxycycline

A

tetracycline antibiotic

causes teeth staining in babies due to localization in the enamel and dentin of developing teeth

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20
Q

a1 agonist

A

contraction of the pupillary dilator muscle (mydriasis)

example: phenylephrine

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21
Q

B2 agonist

A

uterine relaxation used in labor to defer premature labor

include riodrine and terbutaline

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22
Q

congenital rubella syndrome

A

predominantly characterized by neonatal defects of the head (microcephaly, mental retardation), eyes (cataracts), ears (deafness), and heart/CV system (PDA, peripheral pulmonic stenosis)

most classic triad: congenital cataracts (white pupils), sensory neural deafness, and PDA

live attenuated rubella virus vaccine is recommended at 12-15 mos and at 4-6 yrs but also in nonpregnant woman of childbearing age who lack serum antibody against rubella

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23
Q

thiazolidinedione

A

class of medications that decrease insulin resistance by binding to PPAR-y which activates transcriptional regulators of GLUT4 and adiponectin

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24
Q

tx anion gap metabolic acidosis due to DKA

A

insulin and hydration

insulin allows cells to use glucose as an energy source to decrease lipolysis and production of ketone bodies leads to increased serum HCO3

intracellular shift of potassium resulting in a decrease in serum potassium level

rehyrdation with normal saline leads to normalized serum sodium concentration and decreased osmolality

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25
Q

kinesin

A

if knocked out, secretory vesicles in nerve terminals are absent

kinesin is a microtubule associated motor protein whose function is anterograde transport of intracellular vesicles and organelles toward the plus end of microtubules

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26
Q

porphyria cutanea tarda

A

most common disorder of porphyrin syntehsis

following PBG conversion causes photosensitivity

caused by uroporphyrinogen decarboxylase deficiency which is either inherited or more commonly acquired int he presence of iron and of susceptibility factors

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27
Q

vitamin deficiencies in gastrojejunostomy

A

Iron, vitamin B12, folate, fat soluble vitamins, and calcium

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28
Q

congenital toxoplasmosis

A

hydrocephalus, intracranial calcifications, and chorioretinitis

hepatosplenomegaly, rash, multiple neurological abnormalities such as seizures, altered muscle tone, ocular movement defects

transmitted transplacentally by cat litter in the first 6 months of pregnancy

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29
Q

thiamine deficiency

A

infantile beriberi: 2-3 mos, fulminant cardiac syndrome with cardiomegaly, tachycardia, cyanosis, dyspnea, and vomiting

adult beriberi: dry (symmetrical peripheral neuropathy of distal extremities with sensory and motor impairment) and wet ( cardiomyopathy, HO congestive heart failure, peripheral edema, tachycardia)

CNS involvement: Wernicke Korsakoff in alcoholics

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30
Q

SRY gene

A

on Y chromosome

allows XY embryos to develop testes

Sertoli cells: suppress female internal organs by AMH, also produce androgen binding protein which concentrates testosterone in the seminiferous tubules

Leydig cells: secrete testosterone which stimulates Wolffian ducts to develop into internal male organs and external male organs

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31
Q

hypoxic vasoconstriction

A

occurs in the pulmonary circulation so that blood flow is diverted away from underventilated regions of the lungs and towards better ventilated areas where gas exchange occurs more efficiently

MOA: increase in pulmonary artery smooth muscle Ca2+levels

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32
Q

generalized anxiety disorder

A

excessive and chronic worry, feeling on edge, muscle tension, and insomnia

multiple worries about every day issues

treated with CBT and SSRIS/SNRIs

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33
Q

AV node

A

located on the endocardial surface of the RA near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus

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34
Q

pasteurella multocida

A

organism found in the mouths of dogs

occurs within 24 hours and has a mouse like odor due to being indole positive

amoxicillin-clavulanate

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35
Q

Type I Interferons

A

synthesized by human cells in response to viral infections leads to transcription of antiviral enzymes capable of halting protein syntehsis such as RNAse L and protein kinase R

become active only in the presence of dsRNA and allows them to selectively inhibit viral infected cells

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36
Q

spironolactone

A

aldosterone receptor antanogist (with epleronone)

inhibit the effect of aldosterone at the coritcal collecting ducts and collecting tubules

reduces secretion of K+ and h+ by the collecting tubule

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37
Q

splinter hemorrhages

A

Janeway lesions and splinter hemorrhagic streas in the nail bed that appear because of microemboli

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38
Q

primary spontaneous pneumothorax

A

nontraumatic and is found in patients without preexisting lung disease

causes when a large change in pressure results in a break in the visceral pleura

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39
Q

4 niacin dependent enzymes in TCA cycle

A

pyruvate dehydrogenase

isocitrate dehydrogenase

a-ketoglutarate dehydrogenase complex

malate dehydrogenase

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40
Q

pellagra

A

photosensative dermatitis, diarrhea, dementia due to vitamin B3 deficiency

seen in malnourished populations like alcoholism or GI malabsorption

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41
Q

telomerase

A

ribonucleoprotein that adds TTAGGG repeats to the 3’ end of chromosomes

similar to reverse transcriptase enzymes in that it syntheseizes ssDNA using ssRNA as a template

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42
Q

hemophilia

A

X linked recessive bleeding disorder due to decreased levels of factor VIII or IX

components of the intrinsic coagulation pathway and activate factor X

thrombin makes up for the deficiency and leads to blood clotting

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43
Q

radial nerve

A

innervates extensors of the upper limb below the shoulder and provides sensory to the skin of the posterior arm, forearm, and dorsal lateral hand

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44
Q

ulnar nerve

A

weakness in wrist flexion

weakness in finger abduction and thumb adduction

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45
Q

median nerve

A

wrist flexion

thumb opposition

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46
Q

obturator nerve

A

caused by anterior hip dislocation or surgery

decreases thigh adduction

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47
Q

femoral nerve

A

pelvic fracture or mass

flexion of thigh, extension of leg

sensory: anterior/medial thigh and calf

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48
Q

common peroneal

A

fibular neck fracture

lateral calf and dorsal foot

foot eversion, dorsiflexion, toe extension

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49
Q

galactosemia

A

lactose is broken down into galactose and glucose

galactose is then phosphorylated to galactose 1P by GALk

deficiency in GALK leads to increased galacitol–> cataracts

late presentation and normal growth

if GALT deficiency, increased galactose 1 phosphate and more severe

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50
Q

acalculous cholecystitis

A

acute inflammation of the gallbladder in the absence of gallstones

commonly occurs in critically ill patients and is associated with high mortality

arises secondary to gallbladder stasis and ischemia

fever, RUQ, positive murphys, leukocytosis, mild elevation sin LFTs

no gallstones

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51
Q

permissiveness

A

when one hormone allows another to exert its maximal effect

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52
Q

HPV

A

double stranded nonenveloped DNA virus with a predilection for squamous epithelium of the skin and vagina

koilocytes on pap smear

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53
Q

familial dysbetalipoproteinemia

A

defects in ApoE3/E4

found on triglyceride rich lipoproteins like chylomicrons and VLDLs

without them, liver can’t efficiently remove chylomicrons and VLDL remnants from the circulation

disease characterised by xanthomas and premature coronary and peripheral vascular disease

autosomal recessive

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54
Q

tinea corporis

A

annular scaling plaque with well demarcated, raised erythematous borders and central clearing

terbinafine: allylamines; inhibits synthesis of ergosterol of the fungal membrane by inhibiting the enzyme squalene epoxidase

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55
Q

tumor lysis syndrome

A

uric acid crystals precipitate in an acidic environment like the distal tubules and the collecting ducts

obstructive uropathy and acute renal failure follow

tx: urine alkalization and hydration + allopurinol

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56
Q

Western blot

A

Used to detect a target polypeptide or protein from within a mixed sample

Proteins separated by gel electrophoresis then transferred to a membrane and probed with a primary antibody specific for the protein of interest

Membrane is then washed and treated with a secondary marked antibody that binds to the primary antibody and can be detected

Similar to ELISA, but in ELISA they test the serum directly

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57
Q

Northern blot

A

Analyzes mRNA

Large number of mRNA molecules is separated by gel electrophoresis

Then transferred to a membrane and hybridized

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58
Q

Southern blot

A

Analyzes DNA sequences that have been fragmented using restriction endonucleases

Radiolabeled DNA probe containing a sequence complementary to an area of interest is then used for hybridization

Can detect restriction site mutations because they alter DNA fragment lengths

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59
Q

Anaphylaxis

A

Type I hypersensitivity reaction characterized by vascular permeability and multisystem edema

Leads to massive shift of Intravascular fluid to the extravascular compartment

Results from widespread mast cell and basophils degranulation—>leads to release of histamine and tryptase

High affinity IgE receptor aggregation is found on mast cells and basophils and leads to a primary role in mediating the allergic response

Multiple IgE antibodies become cross linked resulting in aggregation of the FceRI receptors on the mast cell surface

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60
Q

Insulin

A

Causes activation of PFK-2 ( increased fructose 2,6-bisphosphonate levels and increased glycolysis)

This leads to inhibition of gluconeogenesis and decreased conversion of alanine and other gluconeogenic substrates to glucose

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61
Q

Familial erythrocytes is

A

B glob in mutation results in reduced binding of 2,3-BPG which leads to increased oxygen affinity of hemoglobin

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62
Q

Phenylketonuria

A

Severe intellectual disability, history of seizures, and abnormal pallor of catecholaminergic brain nuclei on autopsy

Results from the inability to convert phenylalanine to tyrosine (rxn enzyme: phenylalanine hydroxylase)

Requires BH4

Excess phenylalanine and the presence of large concentrations of its metabolites contribute to the brain damage, and have inhibitory effects on melanin synthesis leading to hypopigmentation

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63
Q

Cholestyramine

A

Anti hyperlinked is agent that causes an INCREASE in triglyceride levels

MOA: bile acid resin that inhibits enterohepatic circulation; results in increased synthesis of new bile acids, increased uptake of LDL, and reduced blood lDL

AE: GI upset and impaired absorption of nutrients and drugs, hypertriglyceridemia

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64
Q

Loop diuretics

A

Inhibit Na-K-2Cl symporters in the ascending limb of the loop of Henley

Leads to increased Na, Cl, and fluid excretion

Stimulates prostaglandin release—>vasodilation—>increased GFR and enhanced drug delivery

Inhibited by NSAIDs

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65
Q

Diastolic heart failure

A

Common cause of acute decompensated HF

Characterized by normal left ventricular ejection fraction and end diastolic volume in the setting of increased LV filling pressure

LV diastolic pressure is determined by the blood volume in the LV cavity and compliance of the left ventricle

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66
Q

Ulcerative colitis

A

Recurrent abdominal pain and bloody diarrhea with CT evidence of bowel wall thickening in the distal colon and rectum

Chronic inflammatory conditions are characterized by persistent stimulation of neutrophils and macrophages—>IL1, IL6, TNFa, IFNy

Increased acute phase reactants

Increased ESR

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67
Q

Vertebral osteomyelitis

A

Should be suspected in patients with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially s. Aureus)

Initial evaluation: blood cultures and MRI

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68
Q

C section delivery

A

Midline vertical separation of the rectus abdominals muscle

Horizontal can be considered when more space is needed—>inferior epigastric arteries could be cut

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69
Q

Acute tubular necrosis

A

Due to decreased renal perfusion during his cardiac arrest

Presents with increased serum creatinine and BUN, normal BUN/Cr ratio, Liguria

Predominantly affects the renal medulla. Straight portion of PCT and thick ascending loop of Henle are particularly susceptible

Characterized by flattening of the proximal tubular epithelial cells with loss of brush border and subsequent cell necrosis and denudation of the tubular basement membrane

Muddy brown casts seen

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70
Q

Secondary syphilis

A

Fever, arthralgias, diffuse lymphadenopathy, and widespread maculopapular rash raises suspicions for this

Nontreponemal serologic tests mix patient’s serum with a cardio lipin-cholesterol-lecithin agent

Anti cardio lip in develop in response to the release of lipids from cells damaged by T. Pallium

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71
Q

Clostridium perfringens

A

Rapid metabolism of muscle tissue carbs produces significant amounts of gas—>gas gangrene

Lecithinase is the main toxin: also known as phospholipase C or alpha toxin, catalyzes the splitting of phospholipid molecules

Loses lecithin containing lipoprotein complexes in cell membranes causing cell lysis, tissue necrosis, and edema

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72
Q

Acute intermittent porphyria

A

Autosomal dominant disorder of heme synthesis pathway caused by porphobilinogen delaminates deficiency

Causes nervous system dysfunction due to accumulation of early heme pathway intermediates (PBG and ALA)

Presents acutely with variable GI and neuro symptoms

Reddish urine that darkens on exposure to light and air due to oxidation of excess PBG

Avoid alcohol, smoking, and CYP450 inducing drugs

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73
Q

SubQ insulin

A

Starts working in 30 mins

Peaks in 2-4 hours

Lasts 5-8 hrs

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74
Q

Alzheimer’s disease

A

Cortical atrophy and no other reversible causes

Drug choices:

  1. Enhanced ACh (donepazil: cholinesterase inhibitor)
  2. Neuroprotection via antioxidants (vitamin E)
  3. NMDA antagonism (memantine)
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75
Q

Pancreatic buds

A

Dorsal: majority of pancreatic tissue (body, tail, most of the head)
Ventral: (uncinate, inferior/posterior head, major pancreatic duct of Wirsung)

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76
Q

Paroxysmal nocturnal hemoglobinuria

A

Disorder due to complement mediated hemolysis due to a mutated PIGA gene and decreased GPI anchor proteins

Attaches to CD55 that inactivated complement

Manifestations: fatigue and jaundice due to hemolytic anemia, thrombosis at atypical sites, pancytopenia

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77
Q

Patent ductus arteriosus

A

Continuous murmur along with inspiratory splitting of S2

Best heard in the left infraclavicular region with maximal intensity at S2

At risk patients: premature infants and those with cyanotic congenital heart disease

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78
Q

Vertebral venous plexus

A

Cancers of the pelvis spread to the lumbosacral spine through the vertebral venous plexus which communicates with a number of venous networks, including the prostatic venous plexus which receives venous blood from the prostate, penis and bladder

79
Q

Diffuse esophageal spasm

A

Several segments of the esophagus contract inappropriately at the same time, which appears as disorganized non peristaltic contractions on esophageal manometry and corkscrew esophagus on barium esophagogram

Patients typically present with intermittent solid/liquid dysphasia, chest pain, heartburn, and food regurgitation

Pathogenesis: impaired inhibitory neurotransmission within the esophageal myenteric plexus

80
Q

IV dopamine

A

Can’t cross the BBB due to tight junctions that prevent paracellular passage of fluid and solutes; composed of transmembrane proteins that associated with actin filaments forming a belt like seal around the apical intercellular space

Only permits the passage of substances from the blood to the brain via trans cellular movement

81
Q

Wilson disease

A

Autosomal recessive mutation of the ATP7B gene that results in impaired cellular transport of copper

Leads to decreased copper in ceruloplasmin and reduced biliary copper excretion

Excess copper is cheated with d-penicillamine

82
Q

Alkaptonuria

A

Marked by severe arthritis in adult life

Autosomal recessive

Caused by a deficiency of homogentisic acid deoxygenate

Deposits in connective tissue thru the body

Blue black deposits become apparat the in the sclera and ear cartilage

83
Q

Where is type I collagen found? and what disease is associated with it?

A

dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue

osteogenesis imperfecta (autosomal dominant)

84
Q

Where is type II collagen found?

A

cartilage, vitreous humor, and nulceus pulposus

85
Q

where is type III collagen found? and what disease?

A

skin, lungs intestines, blood vessels, bone marrow, lymphatics, and granulation tissue

ehlers danlos syndrome

86
Q

where is type IV collagen found and what disease is it associated with

A

basement membranes

alport syndrome

87
Q

midshaft humerus fractures

A

deep brachial artery

radial nerve: wrist drop

88
Q

linkage disequilibrium

A

two genetic loci are in this when their respective alleles are inherited together in the same gamete more or less often than expected by chance alone

often the result of physical proximity

89
Q

heteroplasmy

A

presence of different mitochondrial genomes within a single cell type

seen with mitochondrial diseases

90
Q

penetrance

A

the proportion of people with a given genotype who express its associated phenotype

91
Q

pleiotropy

A

occurence of multiple phenotypic manifestations in different organ systems which result from a mutation in a single gene

92
Q

varicella zoster virus

A

enveloped dsDNA virus transmitted via respiratory drops

light microscopy shows intranuclear inclusions in keratinocytes and multinucleated giant cells on a positive tzanck smear

skin biopsy: acantholysis of keratinocytes and intraepidermal vesicles

93
Q

pemphigus vulgaris

A

deposition of IgG containing deposits in a reticular pattern around keratinocytes

immune target: desmoglein 3

94
Q

cavernous sinus thrombosis

A

commonly due to contiguous spread of an infection from the medial third of the face, sinuses, or teeth

common pathogens: staph aureus, strep, fungal: mucor and rhizopus

95
Q

severe combined immune deficiency

A

presents in infancy–> impaired T and B cell development and function

eventual development of severe viral and bacterial infections

mucocutaneous candidiasis, persistent diarrhea, failure to thrive

low or absent CD3+ T cells and hypogammaglobulinemia

96
Q

primary central nervous system lymphoma

A

diffuse, large B cell lymphoma

EBV origin

abnormal T lymphocytes is not commonly seen on brain biopsy

97
Q

meniere disease

A

disorder of the inner ear characterized by increased volume and pressure of endolymph that is thought to be due to defective resoprtion of endolymph

causes low frequency tinnitus, vertigo, sensorineural hearing loss

98
Q

cryptogenic stroke

A

frequently associated with patent foramen ovale (incomplete fusion of the septum fprimum and septum secundum) and atrial septal defect

99
Q

nondepolarizing NMJ blockers

A

do not function in discrete phases; TOF responses always display a fading pattern

include vecuronium, pancuronium, and tubocurarine

reversed with neostigmine

100
Q

depolarizing blocker

A

succinylcholine

prevent repolarizing in phase I and show equal reduction in all 4 twitches

persistent exposure results in eventual transition to phase II blockade where the AChR become desensitized and inactivated

101
Q

chronic lymphedema

A

risk factor for the development of cutaneous angiosarcoma (Stewart Treves syndrome)

histo: infiltration of the dermis with slit like abnormal vascular spaces

prognosis poor

102
Q

central scotoma

A

macular lesions impair central vision

refers to any visual defect surrounded by a relatively unimpaired field of vision

occur due to pathologic processes that involve parts of the retina or optic nerve

103
Q

macular degeneration

A

progressive loss of central vision due to deposition of fatty tissue behind the retina and neovascularization of the retina

104
Q

congenital toxoplasmosis

A

hydrocephalus, intracranial calcifications, and chorioretinitis

hepatosplenomegaly, rash, and neuro abnormalities such as seizures, altered muscle tone, and ocular movement defects

transmitted transplacentally i f the mother is infected during the first six months of pregnancy

105
Q

PaCO2

A

decreased amounts of this substance due to hyperventilation causes vasoconstriction

this reduces blood volume and decreases ICP

106
Q

myasthenia gravis characteristics

A

fluctuating weakness of voluntary muscles

progressive weakness over the course of the day or after exercise

decreased compound muscle action potential amplitude

rapid restoration of strength of affected muscles with rest

caused by autoantibodies against postsynaptic nicotinic acetylcholine receptors

107
Q

gabapentin

A

anticonvulsant that works by inhibiting presynaptic voltage gated calcium channels

108
Q

lactose intolerance

A

presents with intermittent flatulence, crampy abdominal pain, watery diarrhea and worsening symptoms after eating dairy

lactase nonpersistence: declining lactase expression in adulthood, seen in Asian and african populations

can be primary or secondary (caused by injury to mucosal brush border)

decreased lactose hydrolysis leads to acidic stool, increased breath hydrogen content, and elevated stool osmolality

109
Q

acute serum sickness

A

type III hypersensitivity

fever, pruritic skin rash, arthralgias that begin 7-14 days after exposure to an antigen (penicillin, mAB, etc)

histo: fibrinoid necrosis and intense neutrophil infiltration, hypocomplementemia, MILD thrombocytopenia

110
Q

cardiac abnoralities in down syndrome

A

hyperdynamic precordium, mid diastolic rumble at LSB ( INCREASED PULMONARY VENOUS RETURN), 3/6 holosystolic murmur in the apex that radiates to the left axilla (AV VALVE REGURG)

defects in the lower part of the interatrial septum and the interventricular septum

111
Q

cardiac abnormalities in DiGeorge syndrome

A

tetralogy of fallot, truncus arteriosus, transposition of the great arteries

112
Q

thiazide diuretics metabolic abnormalities

A

hypercalcemia
hyperglycemia
hypercholesterolemia
hyperuricemia

hyponatremia
hypokalemia

MOA: inhibition of the Na/Cl cotransporter in the distal tubule

113
Q

familial hypocalciuric hypocalcemia

A

mild hypercemia, low calcium in the urine, high PTH, normal 25-hydroxyvitamin D

benign autosomal dominant disorder caused by a defective CaSR (transmembrane GPCR) in the parathyroid gland and kidneys

114
Q

neurphysins

A

carrier proteins for oxytocin and vasopressin

produced within the neuronal cell bodies of hypothalamic nuclei

point mutation can result in abnormal protein folding and removal from ER leading to decreased vasopressin and central DI (autosomal dominant)

115
Q

capitation

A

payment structuer underlying health maintenance organization provider networks

incentive for the provider and patient to reduce expenses by restricting patients to a limited panel of providers within the plan

116
Q

SA node location

A

RA near opening of SVC

117
Q

AV node location

A

RA near septal cusp of the tricuspid valve

118
Q

methotrexate

A

folate antagonist

normal: folic acid–>DHF–>THF
methotrexate: inhibits DHF reductase leading to DHF which gets polyglutamated

119
Q

Fragile X syndrome

A

mild intellectual disability

small gap near the tip of the long arm of X chromosome–>unstable expansion of trinucleotide repeats (CGG) in the FMR1 gene on long arm of X chromosome

when cultured in folate medium: broken area

classic physical features: macrocephaly, long narrow face, prominent forehead, jaw, chin, ears, macroorchidism

120
Q

Wilson’s disease

A

autosomal recessive; leads to toxic accumulation of copper within organ tissues

60% of copper is absorbed in the stomach and duodenum, then transported to the liver where it is incorporated into an A2 globulin to form ceruloplasmin

121
Q

lipoatrophy

A

redistribution of fat; commonly occurs due to HAART

refers to loss of subcutaneous fat from the face, extremities, and buttocks. seen with NRTIs (stavudine and zidovudine) and protease inhibitors

122
Q

adenomyosis

A

presence of endometrial glandular tissue within the myometrium

relatively common condition in middle aged parous females

sx: heavy menstrual bleeding due to increased endometrial surface and dysmenorrhea due to endometrial tissue growth in the confined myometrial space

123
Q

left heart failure

A

dyspnea, bibasilar crackles, S3 sound in a patient with a recent MI= Left heart failure

MI–>decreased left ventricular contractility and reduced LV output, increased EDP

the high end diastolic pressure impairs return of blood which leads to transudation of fluid from the pulmonary capillaries into the lung tissues. This causes distortion and increased resistance to movement

124
Q

congenital pyloric stenosis

A

males: 3:1

recurrent projectile nonbilious vomiting 2-3 weeks afterbirth

visible epigastric peristalsis and presence of an olive sized mass in the distal stomach or pyloris

olive mass is due to secondary hypertrophy of the pyloric muscularis mucosae

125
Q

nitroglycerin MOA

A

metabolized in vascular smooth muscle cells to nitric oxide which activates guanylate cyclase and promotes the conversion of GTP to cGMP

increased levels of cGMP lead to decreased intracellular calcium and activation of myosin light chain phosphatase which promotes myosin light chain dephosphorylation and vascular smooth muscle relaxation

126
Q

HAV

A

contaminated water or food (shellfish)

hepatomegaly, acute onset, malaise, fatigue, nausea, vomiting, mild abdominal pain, aversion to smoking, increased liver enzymes, bilirubin, alkaline phosphatase

127
Q

cefuroxime

A

2nd gen cephalosporin

beta lactam antibiotic

128
Q

streptomycin

A

aminoglycoside antibioitc that interferes with the 16srRNA of the bacterial 30S ribosomal subunit

resistance: mutations of ribosomal proteins that change the binding sites for the drug

129
Q

i cell disease

A

autosomal recessive lysosomal storage disroder due to defects in protein targeting

present with failure to thrive and cognitive deficits in 1st year of life with characteristic facial features: coarse facial features, corneal clouding

golgi body phosphotransferase catalyzes the phosphorylation of mannose residues on lysosome bound proteins

130
Q

valproate

A

neural tube defects

used to prevent migraines and treat epilepsy and bipolar disorder

interferes with folate metabolism

131
Q

mucormycosis

A

mucor, rhizopus, absodia species–> broad, nonseptate hyphae that branch at wide angles

transmitted by spore inhalation

tend to infect the paranasal sinuses leading to complaints of facial and periorbital pain, headache, purulent nasal discharge

fungi proliferate in the walls of blood vessels and cause necrosis of the corresponding tissue

black eschar can be seen on palate or nasal turbinates

tx: surgical debridement and amphotericin B

132
Q

COPD

A

increased TLC, RV

decreased FEV1/FVC, FVC

due to destruction of the interalveolar walls, decrease in lung elastic recoil, distal airspace enlargement

133
Q

acute epiglottitis

A

rapidly progressive infection due to h. influenzae type B

dx: presence of edematous epiglottis that classically appears cherry red

134
Q

monocular scotoma

A

partial lesion of the retina, optic disc, otic nerve

caused by macular degeneration or optic neuritis

135
Q

right anopia

A

lesion at right optic nerve

caused by retinal artery or central retinal vein occlusion

136
Q

bitemporal hemianopia

A

lesion at optic chiasm

caused by pressure exerted by a pitutiary tumor, craniopharyngioma, aneurysm of anterior communicating artery

137
Q

right nasal hemianopia

A

lesion at right perichiasmal

caused by calcification or aneurysm of the ICA impinging on uncrossed, lateral retinal fibers

138
Q

left homonymous hemianopia

A

lesion at right optic tract or optic radiation

caused by:
optic tract: occlusion of anterior choroidal artery

optic radiation: occlusion of a MCA branch or lesion at posterior limb of internal capsule

139
Q

left homonymous superior quadrantanopia

A

pie in the sky

lesion at right temporal lobe or meyer’s loop

caused by lesion or stroke involving temporal lobe

140
Q

left homonymous inferior quadrantanopia

A

pie on the floor

lesion at right parietal lobe or dorsal optic radiation

caused by lesion or stroke of the parietal lobe

141
Q

left homonymous hemianopia with macular sparing

A

lesion at right primary visual cortex in the occipital lobe

caused by occlusion of the posterior cerebral artery

macula is spared due to collateral blood from the MCA

142
Q

leptin

A

decreases neuropeptide Y in the arcuate nucleus of the hypothalamus

stimulates production of POMC which cleaves a-mSH which inhibits food intake

143
Q

Kozak sequence

A

analogous to the shine-dalgarno sequene in e.coli

defined by (gc)gccRccAUGG in which R is either adenine or guanine

decreases synthesis of the consensus sequence that helps start translation in eukaryotes

disrupts assembly of ribosomal subunits (60S and 40S), mRNA, initiation factors, initiator tRNA charged with methionine, GTP

144
Q

Biotin (vitamin B7)

A

carboxylase enzymes

conversion of pyruvate to oxaloacetate for gluconeogenesis

can occur secondary to poor diet, excessive raw egg white consumption (biotin-binding avidin) and congenital disorders of biotin metabolism

changes in mental status, myalgias, anorexia, chronic dermatologic changes such as macular dermatitis

can also develop metabolic acidosis

145
Q

niacin

A

vitamin B3 used to oxidize glucose 6 phosphate in the pentose phosphate pathway

generates NADPH and ribose-5-phosphate

146
Q

phenoxybenzamine

A

irreversible a1 and a2 receptor antagonist

drug A acts as a noncompetitive antagonist or an irreversible antagonist of a1 adrenergic receptors and effectively reduces the arterial vasoconstriction induced by norepinephrine

147
Q

11q11.2 microdeletion

A

digeorge syndrome

leads to neural crest failure to migrate into the derivatives of the 3rd and 4th pharyngeal pouches

148
Q

alveolar hypoventilation

A

causes low PaO2 and PAO2 but normal A-a gradient1

149
Q

gallstone ileus

A

presents as intermittent abdominal pain and a cholesterol containing mass at the ileocecal valve

mechanical obstruction that occurs with a large gallstone erodes into the intestinal lumen through a cholecystoenteric fistula

signs of small bowel obstruction: abdominal distension, tenderness, and high pitched bowel sounds

air in the biliary tree due to retrograde passage of intestinal gas through the fistula

150
Q

primary myelofibrosis

A

atypical megakaryocytic hyperplasia that stimulates fibroblast proliferation resulting in progressive replacement of the marrow space by extensive collagen deposition

pancytopenia, hepatomegaly, splenomegaly, teardrop shapred RBCs, nucleated RBCs

mutation in JAK2 which leads to constitutively active tyrosine phosphorlyation activity and increased activation of STAT pathway

tx: ruxolitinib

151
Q

conversion disorder

A

neurologic symptoms that are inconsistent with neurological disease

acute onset of muscular weakness following stress, normal neuro exam, negative work up

somatic symptom disorder characterized by symptoms or deficits of voluntary motor and or sensory function that are incompatible with any recognized neurological condition

Sx must be neurological

152
Q

systemic mastocytosis

A

cloncal mast cell proliferation occurs in the bone marrow, skin, and other organs

associated with mutations in KIT receptor tyrosine kinase

characterized by prominent expression of mast cell tryptase

excessive h istamine release from degranulation mediates syncope, flushing, hypotension, pruritis, and urticaria

induces gastric acid secretion and inactivates pancreatic and intestinal enzymes to cause diarrhea

153
Q

pseudomonas aeruginosa

A

non lactose fermenting, oxidase positive, gram negative rod

154
Q

measles

A

fever, cough, congestion, conjunctivitis, maculopapular rash that starts on the face and moves to the trunk

vitamin A supplementation is recommended to help prevent and treat ocular complications such as keratitis and corneal ulceration

155
Q

linezolid

A

MAOI activity and used to treat infections caused by gram negative bacteria such as vancomycin resistant enterococcus and mRSA resistant Staph aureus

can lead to serotonin syndrome

156
Q

tetralogy of fallot

A

cyanotic spells that improve with squatting, prominent right ventricular impulse, harsh systolic murmur

abnormal neural crest cell migration leads to anterior and cephalad deviation of the infundibular septum during embryologic development

4 distinct anatomic abnormalities: VSD, overriding aorta, RVOT obstruction, RVH

157
Q

gastrinomas

A

zollinger ellison syndrome

results in multiple peptic ulcers that can be located beyond the duodenal bulb and are often refractory to therapy

experience abdominal pain and acid reflux

associated with MEN1

158
Q

essential tremor

A

most commonly diagnosed movement disorder

familial tremor that follows autosomal dominant inheritance

worsens while maintaining a particular posture and improve with alcohol consumption

propanolol is the first line treatment due to its CNS effects

159
Q

transtentorial herniation

A

compressed structures:

CNIII: eye down and out, pupil fixed and dilated
PCA: CL homonymous hemianopsia with macular sparing
CL cerebral peduncle: ipsilateral hemiparesis
brainstem hemorrhages: pons and midbrain due to rupture of the basilar artery

160
Q

nitrates

A

must be given a nitrate free interval every day so that tolerance doesn’t devleop

theorized to be due to a decreased vascular sensitivity to nitrates and an increased sensitivity to endogenous vasoconstricting agents

usually timed to occur at night when the patient is sleeping and the heart is working the least

161
Q

FFP

A

treatment for warfarin, coumadin, rodenticide toxiticities

replenishes clotting factors II, VII, IX, and X

also need vitamin K

162
Q

ARR calculation

A

ARR=ERcontrol-ERtreatment

163
Q

proximal tubules

A

this is the location in the kidneys were >60% of water is filtered by the glomerulus, regardless of the patient’s hydration status

164
Q

acute hemolytic transfusion reaction

A

presents with fever and chills, hypotension, dyspnea, chest and/or back pain, hemoglobinuria

can also develop DIC and renal failure

can occur within minutes to hours of a transfusion and are most often due to ABO incompatibility

example of Type II Hypersensitivity where antibodies bind the corresponding antigens on transfused donor RBCs leading to complement activation

165
Q

TCAs

A

strong anticholinergic properites that can lead to significant adverse effects such as confusion, constipation, and acute urinary retention

166
Q

if a patient comes in with major depression and has decreased libido following SSRI tx, what drug can your prescribe

A

buproprion

NE/DA reuptake inhibitor and does not affect serotonin

useful in treating depression with hypersomnia and low energy, causes less weight gain

CI in patients with bulimia, anorexia, and seizure Hx

167
Q

Cori disease

A

usually presents in infancy or childhood with both liver and muscle involvement

sx: hypoglycemia, hepatomegaly, and ketoacidosis

muscle weakness and hypotonia

hepatic fibrosis without fatty infiltration

cytosolic accumulation of glycogen with abnormally short outer chains (limit destrins) due to debranching enzyme deficiency

168
Q

pancreatic pseudocyst

A

potential complication of pancreatitis due to leakage of pancreatic secretions

induces an inflammatory reaction in the walls that leads to granulation tissue without an epithelial lining

fibrosis and thickening occur over time and takes about 4–6 weeks to occur

most common location: lesser peritoneal sac

169
Q

carbon monoxide poisoning

A

carboxyhemoglobin increase

decrease in O2 carrying capacity, O2 content in blood but not the amount of oxygen dissolved in plasma or PaO2

decreased tendency for oxygen to unload in the tissues

170
Q

pus

A

thin protein rich fluid and dead neutrophils

MO and endothelial cells release IL8 to trigger neutrophils to the site of infection via chemotaxis

IL8 also induces phagocytosis in neutrophils

171
Q

Conn’s syndrome

A

primary hyperaldosteronism: hypertension, hypokalemia, metabolic alkalosis and decreased plasma renin activity

primary treatment: surgical resection or aldosterone antagonists like spirinolocatone or eplerenone

172
Q

q fever

A

zoonosis caused by coxiella burnietii

infection occurs through inhalation of bacteria infected by animal waste

acute: nonspecific febrile illness with fever lasting >10 days, fatigue, and myalgias, severe debilitating retroorbital headaches, pneumonia

chronic Q: rare, manifests as infective endocarditis in patients with valvular disease, frequently fatal

173
Q

Stanford Type B aortic dissections

A

involve the descending aorta and originate close to the origin of the left subclavian artery

patient presentation: severe midback pain that started several hours ago, nauseous, diaphoresis, lightheaded

smoker with extremely high blood pressure, sinus tachy, left ventricular hypertrophy with secondary ST segment and T wave changes

174
Q

work of breathing

A

for patients with stiff lungs, this is minimized when the respiratory rate is high and the tidal volume is low

for patietns with high airwary resistance (asthma and COPD), patients breath at a lower rate (slow, deep breaths) in order to minimize the work of breathing

175
Q

What are some complications of long term untreated obstructive sleep apnea?

A

each nocturnal episode of reduced ventilation causes transient hypercapnia and hypoxemia which leads to vasoconstriction, endothelial dysfunction, abnormal venous return and cardiac output, and SNS

leads to pulmonary hypertension and R HF

systemic hypertension can also develop

a fib, CAD, increased risk of SCD

176
Q

leucine zipper

A

c-Jun and c-Fos= nuclear transcription factors that directly bind DNA

coded by proto-oncogenes

southwestern blots are used to identify and isolate proteins that bind DNA

177
Q

P bodies

A

certain mRNA associate with proteins with proteins found in these

distinct foci found within eukaryotic cells involved in mRNA regulation and turnover

178
Q

hemosiderosis

A

chronic hemolytic anemia (thalassemia) depends on RBC transfusions to maintain an adequate hemoglobin level

iron overload (____)from increased iron absorption is a common complication

ferritin micelles accumulate in macrophages of RES system and rest in iron storage complexes as hemosiderin and appear on microscope as brown or yellowish brown pigments in either granular or crystalline form

179
Q

CKD hormonal changes

A

increased serum phosphate, decreased serum Ca, increased FGF23, decreased calcitriol synthesis, increased PTH

180
Q

eNOS

A

catalyzes the reaction of Arginine+O2 and NADPH into NO and citrulline

NO then diffuses into adjacent smooth msucle cells where it activates guanylyl cyclase and increases cGMP–> increased pkG–> decreased Ca2+ levels and relaxation of smooth muscle cells

181
Q

name 4 opsonins

A

IgG
C3b
mannose binding lectin
CRP

182
Q

HbF

A

a2y2

converts to HbA (a2b2) by 6 mos

high oxygen affinity because 2,3-BPG binds poorly

183
Q

DNA polymerase I

A

only prokaryotic polymerase that has 5’–>3’ exonuclease activity

removes the RNA primer created by RNA primase and repairs damaged DNA sequences

184
Q

acute ureteral obstruction

A

increases hydrostatic pressure proximal to the constriction which is transmitted to Bowman’s space and results in decreased GFR

FF=GFR:RPF ratio; decreases because GFR remains depressed to a greater extent than the RPF

185
Q

aging of skin

A

UVB wavelengths predominantly absorbed in the upper dermis and contribute to sunburn and increased risk of malignancy

uVA cause photoaging by producing ROS which leads to decreased collagen fibril production and upregulation of matrix metalloproteinases that subsequently degrade type I and III collagen and elastin

increased crosslinking of collagen wih deposition of collagen breakdown products occurs

186
Q

aspiration pneumonia

A

alcoholics with poor hygeine that usually result from aspiration of anaerobic oral flora (bacteroides, prevotella, fusobacterium, peptostreptococcus)

clindamycin has the most activity against oral anaerobes and also covers gram positive orgs like s. pneumo

tx: binds 50s ribosome to disrupt protein synthesis`

187
Q

psoriasis

A

sharply demarcated, salmon colored, rounded plaques covered with a loosely adherent silvery white scale

Cd4+, Cd8+, dendritic cells, keratinocytes–> increased TNFa, IL 12, IFNy, IL23, IL 17

tx: vitamin D analogs (calcipotriene, calcitriol, taclcitol)

188
Q

norovirus

A

most common cause of viral gastroenteritis

ssRNA linear, nonenveloped (Calicivirus)

sx: diarrhea, vomiting, fever, malaise, headache

diarrhea is watery without blood or mucus due to lack of small bowel inflammation

189
Q

congestive heart failure

A

left sided: dyspnea on exertion, orthopnea, and PND

R sided: LE edema and hepatomegaly

190
Q

oseltamivir

A

neuraminidase inhibitor useful in treatment of influenza A and B

required for the release of virus from infected cells and for the spread of virus within the respiratory tract

causes the newly synthesized virions to adhere to the host cell surface and form viral aggregates to reduce the spread of virus to other host cells

191
Q

ACEi and K+ sparing diuretics

A

leads to an increase in risk of hyperkalemia

192
Q

giant cell arteritis

A

patient presents with headache, visual, muscular symptoms, enlarged temporal artery, and increased ESR=GCA with polymyalgia rheumatica

cell mediated process with inflammatory infiltrate: CD4+ T cells, macrophages, multinucleated giant cells

produce IL6 (tx with tocilizumab)

193
Q

hepatitis C virus

A

> 6 genotypes at hypervariable genomic regions such as those in its 2 envelope glycoproteins

no proofreading 3’–>5’ exonuclease activity built into the RNA polymerase makes many many errors

UWorld Questions I Missed (2 decks)

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